This investigator-initiated new R01 application, in response to PA-10-067, proposes to reduce depression and cancer-related emotional distress, while also improving health behaviors in adult hematopoietic stem cell transplantation (HSCT) survivors using an internet-based intervention in a multi-center randomized controlled clinical trial (RCT). Among adult long-term cancer survivors, those who received HSCT live with some of the highest risks for life-threatening chronic health conditions including cardiovascular disease, diabetes, osteoporosis, and recurrence or second cancers along with other risks. Even more prevalent in HSCT survivors are psychological symptoms that inhibit quality of life, specifically depression and cancer-related distress. Our previous internet intervention has demonstrated efficacy in reducing depression and distress with survivors at a single site, and has pilot tested the efficacy of providing a survivorship preventive care plan. With the proposed improvements and the extension of the intervention to multiple transplant centers we expect to strengthen both the reach and efficacy of the intervention while we advance the science of internet-based providing of health behavior change models to cancer survivors. Specific aims of the project are to: 1) determine whether 2-10 year HSCT survivors with elevated depression or cancer-related distress who are randomized to receive access to a tailored internet-based program report reduced depression and distress when compared with control group survivors who receive a survivorship care plan by mail and delayed access to the internet site (enhanced usual care), and 2) determine whether survivors with low survivorship preventive care adherence (PCA) who are randomized to receive access to the tailored internet-based program, including a survivorship preventive care plan, report increased PCA when compared with control group survivors. The study will examine main effects of the intervention as well as moderating (age <40, chronic graft versus host disease, rural residence, lower income) and mediating effects (health self-efficacy, knowledge of survivorship needs) per Protection Motivation Theory. Further analyses will identify risk factors for disparities in survivorship preventive care adherence in HSCT survivors. The five-site multi-center RCT will enroll N=1200 adult HSCT survivors with internet access. Assessments will occur at baseline, 3 and 12 months. Participants without internet access will be invited to complete the baseline assessment for participation in the risk factor analyses. To our knowledge, this study will be the first to explore the efficacy of a tailored internet-based intervention, enhanced with options for alerts and reminders through individualized SMS messaging, mobile applications and social networking media, to target health behaviors in a cancer survivor population. The program is cost-effective and readily tailored. If effective, the program could be disseminated nationwide for long-term HSCT survivors in all transplant centers and would provide a framework for similar survivorship care models in non-HSCT cancer survivor populations.

Public Health Relevance

Among adult long-term cancer survivors, those who receive hematopoietic stem cell transplantation (HSCT: also called blood, marrow or umbilical cord blood transplantation) live with some of the highest risks for life-threatening chronic health conditions including cardiovascular disease, diabetes, osteoporosis, and recurrence or second cancers. Also prevalent in HSCT survivors are symptoms that inhibit quality of life such as depression and cancer-related emotional distress. In a study with five sites across the nation, this research is designed to test whether a tailored internet-based survivorship program with methods for managing health behaviors improves depression, emotional distress and adherence to health care guidelines in adult HSCT survivors.